Ecchordosis Physaliphora is a benign remnant derived from the notochord that is located along the craniospinal axis.
Malignant counterpart: chordoma
The lesion is typically asymptomatic and may be first recognized on imaging studies.
Usual location: level of clivus or sacrum
Size: usually less than 6 mL; if > 6 mL termed giant
(1) hypointense on T1 and hyperintense on T2
(2) non-enhancing with gadolinium
(3) bony pedicle (stalk) with focal bone destruction
(1) physalliphorous cells with large intracytoplasmic mucin-containing vacuoles in a myxoid amphophilic matrix
(3) absent or rare mitoses
(4) minimal pleomorphism
(5) absence of tumor necrosis
(1) cytokeratin positive
(2) brachyury positive (encoded by TBXT gene)
(3) GFAP negative
(4) Ki67 less than 1%
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